1 Recommendations

1.1 Galcanezumab is recommended as an option for preventing migraine in adults, only if:

they have 4 or more migraine days a month
at least 3 preventive drug treatments have failed and
the company provides it according to the commercial arrangement.

1.2 Stop galcanezumab after 12 weeks of treatment if:

in episodic migraine (less than 15 headache days a month) the frequency does not reduce by at least 50%
in chronic migraine (15 headache days a month or more with at least 8 of those having features of migraine) the frequency does not reduce by at least 30%.

1.3 This recommendation is not intended to affect treatment with galcanezumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

Treatment options for preventing episodic or chronic migraine include beta-blockers, antidepressants and anticonvulsant drugs. If episodic migraine does not respond to at least 3 oral preventive drug treatments, best supportive care (treatment for the migraine symptoms) is offered. If chronic migraine does not respond to at least 3 oral preventive drug treatments, botulinum toxin type A or best supportive care is offered.

For migraine that has not responded to at least 3 preventive treatments, clinical trial evidence shows that galcanezumab works better than best supportive care in both episodic and chronic migraine. It is plausible that galcanezumab may work better than botulinum toxin type A.

For episodic and chronic migraine, the most likely cost-effectiveness estimates are within what NICE normally considers an acceptable use of NHS resources. So galcanezumab is recommended for episodic and chronic migraine.